Translation, cultural adaptation and psychometric evaluation of the Slovene version of the Heart Failure-Specific Health Literacy Scale in patients with heart failure

Figures

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  Fig. 1. Flow diagram of participant inclusion in the study. Flowchart illustrating participant recruitment, eligibility screening, reasons for exclusion, and final inclusion in the study. Boxes represent study stages, and arrows indicate progression through the recruitment process.

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  Fig. 2. CFA path diagrams for the HFsHLS. Standardized path diagrams for CFA models assessing the three-factor structure of the HFsHLS. (a) Original three-factor structure, as proposed by the authors of the instrument. (b) Alternative three-factor structure, in which items 8 and 9 were reassigned between factors (item 9 placed under the Communicative HL domain and item 8 placed under the Critical HL domain). In both diagrams, rectangles represent observed variables (questionnaire items) and ovals represent latent factors. Single-headed arrows represent standardized factor loadings from latent factors to observed variables, and double-headed arrows indicate correlations between latent factors.

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  Fig. 3. Spearman’s correlations for the HFsHLS total score, Functional HL subscale, Communicative HL subscale, and Critical HL subscale. Horizontal bar plots showing Spearman’s correlation coefficients for the HFsHLS total score and subscale scores (Functional, Communicative, and Critical HL) across four outcomes: BHLS, self-rated health, self-care behaviours, and HF knowledge. Each panel represents correlations for one outcome variable. Bars are colour-coded by scale (dark blue = total score; teal shades = subscales) to facilitate visual comparison, while bar length indicates the magnitude of association. Asterisks denote statistically significant correlations (p < 0.05).

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  Fig. 4. Structure of the HFsHLS according to the three-subscale model. Conceptual diagram illustrating the three-subscale structure of the HFsHLS. Items are grouped into Functional, Communicative, and Critical HL domains. The figure highlights theoretical distinctions across subscales relevant to HF self-care.

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  Fig. 5. Translation and cultural adaption process of the HFsHLS. Flow diagram summarizing the main steps of translation and cultural adaption of the HFsHLS into Slovenian, including forward translation, reconciliation, back-translation, expert panel review, pretesting, and preparation of the final version for the psychometric evaluation.